清热解毒法辅助PCI术对冠心病病人临床疗效及MACE影响的Meta分析

Clinical Efficacy and Safety of PCI Combined with Heat-clearing and Detoxification in Patients with Coronary Heart Disease:a Meta-analysis

目的系统评价中医清热解毒方药辅助经皮冠状动脉介入治疗(PCI)术治疗冠心病的有效性及安全性。方法检索清华同方系列数据库(CNKI)、万方知识服务平台数据库(万方)、维普期刊数据库(CQVIP)、中国生物医学文献数据库(SinoMed)、EMbase、MedLine(PubMed)、Cochrane Library等数据库,搜索清热解毒方药辅助PCI术治疗冠心病的随机对照试验(RCT),检索时间为各数据库建库至2019年6月30日。根据预先指定的纳入与排除标准进行筛选,评价纳入研究的方法学质量,并运用RevMan 5.3软件对纳入研究进行数据分析。结果共检索出中文、英文文献1103篇,最终纳入22项合格研究,共计1829例病人。Meta分析结果显示,清热解毒方药+常规治疗(治疗组)与常规治疗(对照组)相比可改善中医症状疗效[RR=1.28,95%CI(1.19,1.38),P<0.00001],降低中医症状积分[MD=-4.34,95%CI(-6.78,-1.90),P=0.0005],改善心绞痛疗效及心电图疗效[RR_(AP)=1.16,95%CI(1.06,1.27),P=0.001;RR_(ECG)=1.51,95%CI(1.18,1.94),P=0.001];清热解毒方药+常规治疗与常规治疗相比可降低术后主要不良心血管事件(MACE)发生率[RR=0.46,95%CI(0.35,0.60),P<0.00001];在降低血清C-反应蛋白(CRP)方面,清热解毒方药+常规治疗亦优于常规治疗[MD=-2.72,95%CI(-3.76,-1.68),P<0.00001];检索到的文献研究中报道不良反应较少。结论现有证据表明,清热解毒方药联合常规治疗可明显提高PCI术后病人的总体疗效,有效清除血清CRP,降低术后MACE发生率,具有良好的临床安全性。

Objective To systematically evaluate the efficacy and safety of percutaneous coronary intervention(PCI)combined with heat-clearing and detoxification in patients with coronary heart disease.Methods China Journal Full-Text Database(CNKI),Wanfang database,Chinese science and technology periodical database(VIP),Chinese Biomedical Literature,EMbase,MedLine(PubMed),and Cochrane Library for randomized controlled trials in patients with coronary heart disease treated with heat-clearing and detoxifying prescriptions ware searched from the establishment of each database to June 302019.The included literatures were screened according to the pre-specified inclusion and exclusion criteria,the methodological quality of the included literatures was evaluated,and the qualified literatures of Meta-analysis were used by RevMan 5.3 software.Results A total of 1103 Chinese and English literatures were retrieved,and twenty-two literatures were included,involving 1829 patients.The result of Meta-analysis show that compared with conventional treatment,heat-clearing and detoxifying prescription+routine treatment could improve the clinical efficacy of traditional Chinese medicine symptoms[RR=1.28,95%CI(1.19,1.38),P<0.00001],reduce the score of traditional Chinese medicine symptoms[MD=-4.34,95%CI(-6.78,-1.90),P=0.0005],improve the clinical efficacy of angina pectoris and electrocardiogram[RR_(AP)=1.16,95%CI(1.06,1.27),P<0.001;RR_(ECG)=1.51,95%CI(1.18,1.94),P=0.001].Compared with conventional treatment,heat-clearing and detoxifying prescription+routine treatment could reduce the incidence of major adverse cardiovascular events(MACE)[RR=0.46,95%CI(0.35,0.60),P<0.00001]and C-reactive protein(CRP)[MD=-2.72,95%CI(-3.76,-1.68),P<0.00001].Few adverse reactions in literatures were reported.Conclusion Current evidence showed that heat-clearing and detoxifying prescription combined with routine treatment could significantly improve the clinical efficacy of patients after PCI,effectively reduce CRP and the incidence of postoperative MACE,with better clinical safety.